Liaison psychiatry

Background to liaison psychiatry

Liaison psychiatry is the
subspecialty of psychiatry that provides specialist mental health
assessment and treatment for patients attending general
hospitals. This includes patients who attend outpatient
clinics or emergency departments, or who are admitted as
inpatients. Liaison psychiatrists work at the interface between
physical and psychological health, dealing with a range of problems
including self-harm, adjustment to illness and physical and
psychological co-morbidities.

Medical and surgical patients have
high levels of mental health problems which can be treated with
psychological or pharmacological methods, and patients with chronic
disease such as diabetes or asthma can benefit from liaison
psychiatry input if they are having difficulties managing their
condition. Liaison psychiatrists work alongside colleagues from a
wide range of medical and surgical specialities; the clinical
content of liaison psychiatry practice is amongst the most complex
of any medical speciality, and every day brings a new
challenge.

A further important role of a
liaison psychiatrist is the training and education of general
hospital colleagues in order to improve their knowledge, skills and
confidence in the basics of management of the common mental health
problems (depression, dementia, delirium, anxiety) that they
encounter in their day-to-day practice. If you are a skilled
clinician who likes a challenge, enjoys working with a wide range
of colleagues, and are a good teacher and communicator, then
liaison psychiatry may be for you.

Personal perspective

I am currently an academic
specialist registrar (SpR) in liaison psychiatry and I just can’t
understand why every student doesn’t want to do psychiatry – but I
am biased!

I decided to become a psychiatrist
after my fourth year medical student placement. I love the way that
you get to know your patients as people and keep up relationships
with them, often for many years. I also love the fact that you have
to really use your brain in order to make a diagnosis – I find the
lack of diagnostic tests a real challenge, and much prefer
constructing management plans suited to an individual person rather
than going by protocols according to a diagnostic label as so many
other specialties do. I suspect that psychiatry will change more
that any other specialty over the course of my career given the
rate of accumulation of new evidence in neurosciences and
psychological interventions.

During my training, I have been
lucky to experience a really broad range of subspecialties,
including psychiatric intensive care, work with asylum seekers,
psychotherapy, learning disabilities, crisis resolution, perinatal
psychiatry, addictions, services for gender identity disorder,
post-traumatic stress disorder, eating disorders and chronic
fatigue. Psychiatry offers so much variety that everyone seems to
be able to find a niche somewhere.

I also managed to complete a MSc in
psychiatry as a senior house officer (SHO). The course was a great
help in preparing for College exams and provided a day a week away
from clinical work! Should there be something positive about having
protected time away from the clinical job?

By the end of my SHO training, my
main interests became teaching, psychotherapy and liaison
psychiatry and I secured a SpR post with four weekly teaching
sessions and the opportunity to gain accreditation in liaison
psychiatry. Liaison psychiatry seemed the perfect solution to
use my interests in teaching and psychotherapy in a hospital
setting.

Liaison psychiatry is the practice
of psychiatry in the general hospital setting – the interface
between physical and mental health. The rates of mental health
problems (delirium, dementia and depression, for example) are
astounding in general hospital inpatients, and are often poorly
recognised and managed. It is well known that mental health
problems in hospital inpatients increase morbidity, mortality,
length of stay and rehabilitation. Education of medical staff
coupled with simple interventions can often have a dramatic effect
on patient outcomes, which I find incredibly satisfying. I
particularly enjoy developing relationships with my medical
colleagues and working within the hospital culture (including the
mess!) In addition, I have the opportunity to work psychologically
with patients adjusting to living with chronic illness, and those
who are struggling to make sense of medically unexplained
symptoms.

A typical working week would
include two out-patient clinics, taking referrals from hospital
colleagues (this week included a lady with a body mass index of 9
and a man with dissociative amnesia), supervising juniors and
nurses assessments, attending a psychotherapy work discussion
group, providing a lunchtime teaching session to medical SHOs,
preparing and giving lectures for medical students and MSc
students, helping to run a pain management group and providing
input to the asthma multi-disciplinary team meeting.

All SpR on calls are done from home
– a big bonus to my social life. Even better is that I am
currently expecting my first baby, and have been able to take plan
a full year of maternity leave and return to work part-time. I
have also been excused from working on call whilst pregnant – we do
seem to get treated much better than our medical colleagues in this
respect, and I am thus very privileged to do a job I love that also
allows me time to enjoy my family.